Cerebral Arteriogram

(Cerebral Angiography, Cerebral Angiogram)

Procedure overview

What is a cerebral arteriogram?

An arteriogram, also called an angiogram, is an X-ray image of the blood vessels. It is performed to evaluate various vascular conditions, such as an aneurysm (ballooning of a blood vessel), stenosis (narrowing of a blood vessel), or blockages.

A cerebral arteriogram is an arteriogram of the blood vessels of the brain.

How is an arteriogram performed?

An arteriogram involves inserting an arterial catheter (a long thin tube) into a large blood vessel and injecting contrast dye. This contrast dye causes the blood vessels to appear opaque on the X-ray image. This allows the doctor to better visualize the structure of the vessel(s) under examination.

Many arteries can be examined by an arteriogram, including the arterial systems of the legs, kidneys, brain, and heart.

For a cerebral arteriogram, arterial access is usually obtained in the femoral artery in the groin. Occasionally, the brachial artery in the arm may be used, and, in very rare instances, the carotid artery in the neck may need to be used. The femoral artery is most commonly used because it is generally easier to access. Once the catheter is inserted, the contrast dye is injected, and a series of X-ray pictures is made. These X-ray images show the arterial, venous, and capillary blood vessel structures and blood flow in the brain.

Other related procedures that may be used to diagnose brain disorders include X-rays, magnetic resonance imaging (MRI) of the brain, and computed tomography (CT scan) of the brain. Please see these procedures for additional information.

Reasons for the procedure

A cerebral arteriogram may be performed to detect abnormalities of the blood vessels within or leading to the brain. Such abnormalities include aneurysms, stenosis, arteriovenous malformation (a condition in which there is an abnormal connection between the arteries and veins), thrombosis (a blood clot within a blood vessel), vasospasm (a spasm of the blood vessel causing an irregular narrowing of the vessel), or occlusion (complete obstruction of a blood vessel).

A cerebral arteriogram may be performed to locate clips on blood vessels placed during previous surgical procedures, and/or to evaluate the condition of such clipped vessels after a clipping procedure.

A cerebral arteriogram may be recommended after a previous test, such as a CT scan, indicates the need for further information that may be obtained by this procedure.

There may be other reasons for your doctor to recommend a cerebral arteriogram.

Risks of the procedure

You may want to ask your doctor about the amount of radiation used during the procedure and the risks related to your particular situation. It is a good idea to keep a record of your past history of radiation exposure, such as previous scans and other types of X-rays, so that you can inform your doctor. Risks associated with radiation exposure may be related to the cumulative number of X-ray examinations and/or treatments over a long period of time.

If you are pregnant or suspect that you may be pregnant, you should notify your health care provider. Radiation exposure during pregnancy may lead to birth defects. If it is necessary for you to have a cerebral arteriogram, special precautions will be made to minimize the radiation exposure to the fetus.

There is a risk for allergic reaction to the dye. Patients who are allergic to or sensitive to medications, contrast dye, or iodine should notify their doctor. Also, patients with kidney failure or other kidney problems should notify their doctor.

Patients with liver or thyroid conditions should notify their doctors. In some cases, this procedure is not advised for patients with these conditions.

Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.

Because the procedure involves the blood vessels and blood flow of the brain, there is a small risk for complications involving the brain. These complications may include, but are not limited to, the following:

Loss of consciousness

Transient ischemic attack (TIA, a brief stroke-like condition)

Hemiplegia (paralysis of one side of the body)

Embolus (clot in the blood vessel)

Hemorrhage (bleeding)

Hematoma (an area of swelling caused by a collection of blood)

Cerebrovascular accident (stroke)

aphasia (loss of the ability to speak or the ability to understand speech)

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

Before the procedure

Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.

You will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if something is not clear.

Notify your doctor if you have ever had a reaction to any contrast dye, or if you are allergic to iodine.

Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).

You may need to fast for a certain period of time prior to the procedure. Your doctor will notify you how long to fast, whether for a few hours or overnight.

Notify your health care provider if you are pregnant or suspect you may be pregnant.

Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.

You may receive a sedative prior to the procedure if necessary.

Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.

Depending on the site used for injection of the contrast dye, the recovery period may last several hours. You should be prepared to spend the night if necessary.

Your doctor may request a blood test prior to the procedure to determine how long it takes your blood to clot. Other blood tests may be done as well.

Based on your medical condition, your doctor may request other specific preparation.

During the procedure

Carotid Angiogram

A cerebral arteriogram may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor's practices.

Generally, a cerebral arteriogram follows this process:

You will be asked to remove any clothing, jewelry, hairpins, dentures, or other objects that may interfere with the procedure.

If you are asked to remove clothing, you will be given a gown to wear.

You will be reminded to empty your bladder prior to the start of the procedure.

You will be positioned on the X-ray table.

You may be connected to an EKG monitor that records the electrical activity of the heart and monitors the heart during the procedure using small, adhesive electrodes. Your vital signs (heart rate, blood pressure, and breathing rate) and neurological signs will be monitored during the procedure.

If the catheter will be inserted into the groin or the arm, the radiologist will check your pulses below the site and mark them with a marker so that the circulation to the limb below the site can be checked after the procedure.

The catheter will be inserted into an artery in either your neck or your groin after the skin is cleansed and a local anesthetic is injected. On occasion, an artery in the elbow area of the arm may be used instead. The head will be immobilized to prevent the risk of damage to the artery that might occur due to movement of the head. If the groin or arm site is used, the site will be shaved prior to insertion of the arterial catheter. If the arm site is used, a blood pressure cuff will be applied to the arm below the insertion site and inflated to prevent flow of the contrast dye into the lower arm.

Once the catheter is inserted into the artery at the groin or arm site, a special type of X-ray, called fluoroscopy, may be used to verify the location of the catheter inside the body.

An injection of contrast dye will be given. You may feel some effects when the dye is injected into the IV line. These effects include a flushing sensation, a salty or metallic taste in the mouth, a brief headache, or nausea and/or vomiting. These effects usually last for a few moments.

You should notify the radiologist if you feel any breathing difficulties, sweating, numbness, or heart palpitations.

After the contrast dye is injected, a series of X-rays will be taken. The first series of X-rays shows the arteries, and the second series shows capillary and venous blood flow.

Depending on the specific study being done, there may be one or more additional injections of contrast dye.

Once sufficient information has been obtained, the arterial catheter will be removed and pressure will be applied over the area to keep the artery from bleeding.

After the site stops bleeding, a dressing will be applied to the site. A sandbag or other heavy item may be placed over the site for a period of time to prevent further bleeding or the formation of a hematoma at the site.

After the procedure

Depending on which site was used for injection of the contrast dye, you will remain flat in bed in a recovery room for several hours after the procedure. If the groin or arm site was used, the leg or arm on the side of the injection site will be kept straight for up to 12 hours. If the neck site was used, you will be monitored for signs of hoarseness, difficulty in breathing, or pain/difficulty in swallowing.

A nurse will monitor your vital signs, your neurological signs, and the injection site while you are in the recovery room.

You may be given pain medication for pain or discomfort related to the injection site or to having to lie flat and still for a prolonged period.

You will be encouraged to drink water and other fluids to help flush the contrast dye from your body.

You may resume your usual diet and activities after the procedure, unless your doctor decides otherwise.

When you have completed the recovery period, you may be returned to your hospital room or discharged to your home. If this procedure was performed as an outpatient, you should plan to have another person drive you home.

Home instructions

Once at home, you should monitor the injection site for bleeding. A small bruise is normal, as is an occasional drop of blood at the site.

If the groin or arm was used, you should monitor the leg or arm for changes in temperature or color, pain, numbness, tingling, or loss of function of the limb.

Drink plenty of fluids to prevent dehydration and to help pass the contrast dye.

You may be advised not to do any strenuous activities or take a hot bath or shower for a period of time after the procedure.

Notify your doctor to report any of the following:

Fever and/or chills

Increased pain, redness, swelling, bleeding, or other drainage from the groin injection site

Coolness, numbness and/or tingling or other changes in the affected extremity

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.

Online resources

The content provided here is for informational purposes only, and was not designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your doctor. Please consult your health care provider with any questions or concerns you may have regarding your condition.

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